Nix Health Care Foundation Outreach Programs
About Us
Outreach Programs
Fellowships/Scholarships
Giving/Special Events
Calendar of Events
Resources
Contact Us
 
Speakers' Series
Events and
   Registration
Screenings, Workshops
   and Seminars
Events and
   Registration
Senior Gold
Events and
   Registration

Become a Member
Benefits
Services
Sports Medicine Center
Continuing Medical
   Education
Baby Alumni Club
Application

Baby Alumni Club Application
Anyone born at the Nix Hospital is eligible to become a member of the Nix Baby Alumni Club. Please tell us where to send the Certificate of Membership. Fill in the appropriate information. Fields marked with red are required to submit the form.
 
Yes, I was born at the Nix Hospital.
Mr. Mrs. Miss Dr.
*First Name
*Maiden Name
*Last Name
*Birthdate M/D/Y (Example: 09/09/50)
*Phone
Fax
E-mail
*Address
*City
*State
*Zip code